California Forum for Workplace Health and Safety

Injured Worker Needs
Good morning! I'm glad to be here, and to see so many participants. As mentioned,
I am vice president of the CTD Resource Network, which received federal nonprofit
status in early 1999. It was created to bring together existing, online educational
publications under a nonprofit organization and provide a vehicle to more directly
assist those suffering from, or at risk of, cumulative trauma disorders. So
far we offer web?based information related to computer injuries and MSDs generally-such
as the Typing Injury FAQ, or TIFAQ, website-and links to a wide range of resources;
we publish The RSI Network newsletter; moderate several online forums; host
web pages for local RSI support groups; and list RSI and injured worker groups
internationally. [Ironically, using computers.]

Before co?founding this organization, I founded and led an RSI support group
in Oakland for more than eight years, and helped give birth to a number of other
such groups throughout the Bay Area. The format was monthly meetings with specialist
speakers on topics covering the gamut of issues affecting injured workers. As
word of the group spread, I began spending most of my free time listening to
and counseling injured workers who phoned from all over the country. One year
I received almost 1,200 calls!

With each call I became increasingly angry hearing about
- lives devastated by preventable injuries
- claims officers spending more money on blocking treatment than the treatment
would have cost
- sending people to doctors who didn't understand the nature of the injuries
they were seeing
- so?called independent medical examiners who have forgotten the beginning of
the Hippocratic oath: "First, do no harm"
- Employers discarding injured workers like pieces of trash

This the background for my discussion of four primary needs. [This says nothing
about medical needs, which would be the subject of an entire forum in itself.]

I made an acronym to help you remember them: P A I R. Pair has another meaning
in the context of work. It takes a pair to accomplish the mutual goals of management
and labor. If management and labor are not working together cooperatively, many
workers may get injured and a company will not be as effective or as profitable
as it could be. If management takes care of its workers, workers will take care
of the enterprise.

Now, to the acronym PAIR and four of the needs I see as critical: prevention,
accommodation, information, and rehabilitation.

P is for prevention, and there are two aspects to it. The first is preventing
work injuries to begin with. The second is preventing reinjury if workers do
become injured and ultimately are able to return to work.
I can't say enough about the importance of prevention, and the simple things
that can often be done to prevent injuries. Some of them-like musculoskeletal
injuries-that haven't been treated early enough, are treated inappropriately,
or are not amenable to a quick fix, can become chronic and lead to even more?disabling
conditions. They can be catastrophic for workers and their families, for insurers,
and ultimately for government entities to which disabled former workers are
forced to turn for assistance. If employers had to bear the full costs of injuring
workers, sometimes permanently, they would put far more effort into prevention.

A is for accommodation. This can mean accommodating injured workers' new needs
to perform the same jobs.

However, there is a second kind of accommodation, which requires more imagination
and creativity: assessing workers' strengths and helping them develop other
skills, so they can build on their knowledge of the enterprise and continue
to be important assets. Accommodation is a win/win for everyone. Workers will
be able to reclaim their lives, and will be the most loyal employees.

*Especially* if employers have ignored prevention, they owe it to their employees
to go out of their way to accommodate workers' return to the labor force. Many
other employers won't even consider hiring workers who need accommodation, despite
the ADA.

I is for information, both pre? and post?injury.

When workers are hired, they need to know about the potential dangers of their
jobs and how to avoid injury; that they have a right to treatment if they are
injured and to predesignate a treating physician; that employers are required
to have an Injury and Illness Prevention Program. California should mandate
employers to involve workers in these programs; their contributions can be critical
in changing problem jobs or work processes. California also needs to monitor
compliance.

After an injury and throughout treatment, especially when workers have complex
and often misunderstood conditions, information is needed on a wide range of
subjects. Finding it is often exceedingly difficult even for highly educated,
skilled workers, whether or not they have attorneys.

For unskilled, poorly educated, and immigrant workers-who are a growing part
of California's labor force-the situation is disastrous. A great number of them
lack access to basic health care, few of them know about Workers' Comp, their
entitlement to treatment, how to report injuries, or where they can get care.
Rural workers have far greater difficulties getting help navigating through
the system and getting fair settlements that will enable them to take care of
their future injury?related medical needs. In addition, the method for assessing
benefit levels for agricultural and other transient workers with multiple employers
doesn't allow enough money to live on.

Once people are injured they need more than piecemeal information about Workers'
Comp. They need written information explaining their rights, giving an overview
of how the medical?legal process works at different points, and where to get
help. I've had to tell people about the *existence* of Information & Assistance
offices! The Injured Worker Factsheets prepared for the Commission on Health
and Safety and Workers' Compensation by LOHP are a good starting point. I think
employers should be required to post them in a visible place, and insurers required
to give them to workers as soon as injuries are reported.

As cases progress, injured workers often need much more specific information
explaining the medical?legal process, how to change treating physicians, how
to select QMEs, their rights to protect themselves from QMEs who may be dishonest
or venal; how to appeal decisions; when they may need a lawyer, and so forth.
Most of the injured workers I know see the system as a Kafkaesque, wasteful
nightmare. Many employers here may share that sentiment. Peer support groups
are few and far between, many people can't get to meetings, and these volunteer
groups lack the resources to meet more than a fraction of workers' informational
needs.

This barely scratches the surface, but it's time to move on to the fourth primary
need.

R is for rehabilitation. Rehabilitation is an endangered, yet essential component
in returning people to work and making them whole. Vocational rehabilitation
needs to be retained, reformulated, and refunded. The present system serves
few people well, especially those with serious chronic injuries. These are the
people who are least likely to find jobs and the most likely to need help. For
example, according to a number of rehab counselors, only a few percent of the
available jobs can be done by people with chronic musculoskeletal injuries.
More time is needed to develop rehab plans, considerably more money, and more
assistance than injured workers get now-including help from trained social workers.
This sounds to me like a job for a much better funded Department of Rehabilitation!

Poorly educated people with low?level work skills and limited English?language
skills are not even on the charts when it comes to vocational rehab. Not everyone
can return to work with a voice?activated computer, and not everyone will find
jobs they are able to do. I wonder how many homeless Californians landed in
their present situations because of work injuries . . .

And I wonder how long it will take before the expert staff at the agencies
that designed this conference will begin a thorough redesign of Workers Compensation,
looking holistically at all the interrelated parts-including prevention, in
collaboration with occupational health specialists and labor economists in state
agencies, the University of California, and elsewhere-and then work to convince
state legislators and the governor to take a draught of courage and establish
a system whose primary purpose is to help people, and not merely to limit employer
liability.